chapter

16Exercise and Older Adults

Getting Older in America

From U.S. Department of Health and Human Services, 2003, A profile of older Americans: 2003 (Washington, DC).

General Changes Caused by Aging

Most physiological structures decrease in function as we age, but the rate of change is different for each structure. Affected structures include– the cardiovascular system,– the nervous system, and– muscle mass.

Individual Differences

• Each of us ages differently.– Genetic factors– Environmental factors (education, health care,

nutrition, exercise)• A person can be intellectually young but

physically old.

What Happens As People Age?

• People become older and wiser.• Strength and cardiovascular fitness

decrease; body weight increases.• Changes are linked to increased risk of

heart disease, diabetes, osteoporosis, and falls.

• Seniors need to stay fit to enjoy life and retirement.

Health Concerns With Aging

• Health– In 2003, 75% of older White Americans rated their

health as excellent or very good.– Only 58% of African Americans and 61% of

Hispanics did the same.• Physical disabilities

– Most older (≥65 yr) adults have one disability.– Of older adults, 38% have a severe disability.– Disabilities interfere with the ability to do ADLs.

Chronic Conditions in Older Individuals

Most have a chronic health condition; many have multiple chronic health problems. The following are the most common chronic conditions:– Hypertension (49%)– Arthritis (36%)– Heart disease (31%)– Any cancer (20%)– Diabetes (15%)

Age and Cardiorespiratory Fitness(VO2max)

Adapted from J. Romijn, E.F. Coyle, L.S. Siddosis, A. Gastaldelli, J.F. Horowitz, E. Endert, and R.R. Wolfe, 1993, “Regulation of endogenous fat and carbohydrate metabolism in relation to exercise intensity and duration,” Am J Physiol Endocrinol Metab. 265: E380-391. Used with permission.

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Age and Muscle Mass

Adapted, by permission, from M.A. Rigers and W.J. Evans, 1993, “Changes in skeletal muscle with aging: Effects of exercise training,” Exercise and Sport Sciences Reviews 21: 65-102.

Age and Strength

• After age 50, strength decreases 15% per decade.

• After age 70, strength decreases 30% per decade.

Age and Body Composition

• Body fatness increases from 25 to 75 yr of age:– In men, 16% to 25%– In women, 28% to 41%

• There is about a 10 kg (22 lb) increase in fat for each group.

Age and Flexibility

Joint motion decreases with age. It is related to the condition of– muscle,– connective tissue, and– cartilage.

Are Age-Related Changes Inevitable?

• Yes! Part is due to a real aging effect:– The number of muscle fibers decreases with age.– Maximal HR decreases with age.

• No! Part is due to a less active lifestyle: Without question, training programs increase both muscular strength and cardiovascular endurance.

• Chronological age may not equal physiological age: Performance ability greatly varies among individuals the same age (e.g., Senior Games).

Good News: Exercise Helps!

• Older individuals respond to training like younger adults, though rate of change may be different.

• Endurance exercise lowers blood pressure and improves insulin sensitivity.

First Things First

• Have a comprehensive physical exam.• Determine risk factors, risk stratification.• Establish contraindications to exercise,

orthopedic limitations.

Exercise Testing Equipment

• Choose the work instrument carefully.• A cycle ergometer is a good choice, but

cadence may be an issue. The ergometer is a good choice for clients with orthopedic concerns.

• When using the treadmill, focus on slower speeds.

Exercise Testing Progression

Follow a rate of increase similar to that for extremely deconditioned individuals.

Functional Testing: Rikli and JonesSenior Fitness Test

The Senior Fitness Test includes functional tests that address various fitness components:– Chair stand, 8 ft up and go– Arm curl– 6 min walk, 2 in. step– Chair sit and reach, back scratch– Height and weight

Benefits of Exercise

• Endurance exercises– Improved cardiovascular function– Muscles more sensitive to insulin

• Strength exercises– Needed for optimal function in daily tasks– Reduced risk of falls

• Flexibility exercises– Maintenance of joint function, range of motion– Reduced chance of injury or fall

Guidelines for Cardiorespiratory Fitness

• Based on increasing moderate, everyday activity

• Standard structure– Warm-up structure– Warm-up, stretch– Cool-down, stretch

• Strong focus on individuals in group– Individuals vary greatly– Athletic old versus old old

Exercise Prescriptionfor Cardiorespiratory Fitness

Intensity Base target HR on measured maximal HRInitially emphasize low end of the continuum Use RPE

Duration 5 to 10 min segments

Frequency 3 days a week

Training and CR Fitness (VO2max)

• Endurance training increases VO2max 10% to 30%.

• In men, increase is due to increases in both cardiac output and oxygen extraction.

• In women, increase is due primarily to increase in oxygen extraction.

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Exercise the Major Muscle Groups

• Begin with minimal resistance for first 8 wk.• Do 8 to 10 exercises involving major muscle

groups.• Do 1 set of 10 to 15 lifts.• Exercise 2 days each week (48 hr between

workouts).• Stay within pain-free ROM.• Do not exercise if joint is painful or

inflamed.

Resistance Training

• Helps maintain strength • Easier ADL• Reduced risk of falls• Maintains fat-free mass• Higher metabolism• Good for weight control• Improved self-esteem

Body Composition and Age

• Weight gain– Due more to a decrease in energy expenditure than

an increase in caloric intake– Attenuated by regular lifelong exercise

• Exercise intervention– Decreases fat in abdominal area– Lowers risks of cardiovascular and metabolic

diseases

Balance and Falls

Decrease in balance is a complex problem involving such factors as these:– Lack of strength– Vision problems– Proprioception problems– Medications– Illnesses– Reduced flexibility– Environmental hazards

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Balance and Falls (continued)

Fall resistance can be improved with– balance training,– resistance exercises,– walking, or– weight transfer exercises.

Bone Density

• Bone density decreases with age at a rate similar to that of the decrease in fat-free mass.

• The decrease is related to an increased risk of bone fractures.

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Bone Density (continued)

• Exercise and calcium are important but cannot substitute for loss of estrogen.

• Programs should focus on variety, using– fast rather than slow movements and– relatively vigorous activity (>70% of capacity).

Flexibility Exercises

• Maintain muscle length• Stretch muscles and connective tissues• Maintain range of joint motion• Maintain health of joint tissues• May decrease risk of falls• Improve reaching for objects

Flexibility Programs

• Stretch major muscle groups.• Stretch through full range of motion of joint.• Stretch before and after workout.• Hold static stretches to point of mild tension

(not pain).• Dynamic stretches are done slowly.• Consider classes like tai chi or yoga.• Videotapes can also be effective.